How Tiny?!?!

A nursing student in their final semester trying to survive working with the smallest, but mightiest population. 

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Hope to return to the unit as a new graduate nurse

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My NICU Bible

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Reflect on how you would interpret lab values and point of care testing to influence prioritization of nursing care for a patient with type 1 diabetes.

I would always want to see a blood sugar first as it can tell you lots of information in a short amount of time (hyper vs hypoglycemia). In an emergent situation it would be difficult to thoroughly assess if the clients diabetes is well maintained so I would want blood tests in order to determine pH and ketones (risk of DKA), creatinine (kidney damage) and C-insulin to monitor how much insulin is being created.

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Care Planning

My approach to care planning has not changed too much over the semesters. I look at the situation as a whole and decipher what areas of care are to be highlighted using Maslow's Heiarchy of Needs. The same approach will be taken for the cumulative performance.

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When it comes to ethics I find it simple just to refer to the College of nurses’ practice standard. Our regulatory body has already outlined what standard we should be upholding. Their framework is easier to follow than a ethics academic paper. Relational practice constantly flows through my nursing process due to the fact values of it are, recognizing your values and beliefs, respecting the client, and acknowledging how socioeconomic and political issues affect clients (Zou, 2016). For the CP we will be working with a client of the indigenous population. This does not mean I will treat the client differently from the beginning, but I will be aware of some of the barriers they might be facing and investigate further about the care that is needed.

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We love our nursing colleagues, but we do not trust them

- Nurse advising me to double check orders

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Avoiding bias

As mentioned earlier FIcare is a large component of the NICU and is a standard that is to be maintained even if the nurse does not enjoy the principles. It was found there can be resistance to involve parents in care (Daneman, Macaluso, & Guzzetta, 2003). I have noticed this among the unit sometimes. An element of documentation is recording parent involvement Shield’s (2011) argues that family centered care is a great ideal but is difficult to truly obtain due to peoples understanding of it can vary. Sometimes during handover or just through casual conversation with colleagues an image, whether its accurate or not, can be drawn about the family and influence care even if that nurse has never been with them. To help me avoid bias found in the clinical setting I will try to be an objective practitioner and investigate these assumptions myself. We need to go beyond the surface level and discover why parents have been deemed as “difficult”. Perhaps there is anxiety that is being portrayed as overbearing.

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How do I move this horn?

- me, staring at a baby with a CPAP apparatus

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From novice to expert...then back to novice

Patrica Benner's (2001) work is like the most used nursing framework by new graduates and professionals in navigating the healthcare setting. Although I know it takes years to transition through the spectrum, during consolidation I had expectation that I was supposed to be a highly functioning student that could hit the ground running. This did not happen and thus resulted in me not being satisfied with my placement in the beginning. Each semester I built on my previous experiences and knowledge. For my consolidation it was like I was starting at day one again being in a new institution and working with a unfamiliar population. I came to eventually accept this fact and I found that my learning improved because I was allowing myself the space to learn and ask questions. This weight of the unrealistic expectations I had of myself suddenly fell away. As I approach becoming a new graduate nurse I will allow myself the time to transition through each of Benner’s stages of competence.

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Expanding our knowledge at the Canadian Paediatric Society annual conference.

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Electronic charting is relatively new to the sinai health system. Being able to easily find information such as progress notes from physicians, allied health and imaging removes some of the barriers found in paper charting such a

The CNO defiens body of knowledge as “Draws on diverse sources of knowledge and ways of knowing; including the integration of nursing knowledge from the sciences, humanities, research, ethics, spirituality, relational practice, critical inquiry and primary health care principles.” (CNO,2014).

I rely heavily on the sciences for my body of knowledge because as a new graduate I wpuld like to piece together the “why” of things. The pathophysiology of things will help with this goal.

I also sought out addiational information by attending a peadiatric conference, using the knowledge from academic scholar to help inform my practice and see what current in the field of pediatrics.

Photo: https://docplayer.net/amp/3816297-Provider-quick-reference-emr-guide.html

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Clustering care (minimizing handling) is a very important element of the NICU. By handling every 4 (sometimes 6 in special cases) we reduce the stress the baby would go through if we had to disturb them multiple times throughout the day.

Photo: http://www.babyfirst.com/en/developmental-care/

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In order to be relational in our practice, we need to go beyond the technical aspect of the nursing profession. In order to truly engage with clients we need to connect with them in a authentic way (Wright & Brajtman, 2011). The NICU uses a family integrated care model to try and engage parents in an authentic way. I found myself constantly using it as the goal is to build the parents confidence in caring for their child and have them involved in care. This model aims to be authentic and relational due to the fact that the “power” is being presented to parents in a transparent way. Although some may not agree with this model I believe it is a great way to think about how family centered care can be expanded and applied to not only a pediatric setting. Relational knowing allows for the ability to connect with a patient in a meaningful way.

Photo: https://contact2.mshri.on.ca/ficare/

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Sometimes it’s having the courage to say no and that you are not ready, to speak up and ask for help. My first week I was exposed to many novel things. This was my first time in a pediatric population and and it was difficult trying to get reoriented to the unit. I felt that I was clinging tightly to my adult experiences and physiology that at times were not relevant. I was looking for something familiar in a very different setting. For the past five semester I had been building on previous experiences to help navigate the transformative practicum. This placement I needed the courage to let go of previous experiences and accept the fact that I am in a nee environment. It is an uncomfortable feeling but I knew with the support of my preceptor I could navigate these novel situations. By having an open mind I was able to still recognize overlaps witithin the adult word such as your head to toe assessment and the nurse client relationship with the family. An attribute of student courage is that of self advocacy (Gibson, 2018). As I create my learning plan I realize how important is for me in this setting to advocate formyslef and my learning needs to have a successful consolidation.

For the cumulative performance courage will come into play in a similar way. There is always discomfort associated with unfamiliat situtions, which all of the performances hold elements of. By stepping outside my comfort zone and learning about unfamiliar populations or pathologies I am building my ability to act courageously.

Photo: https://www.nme.com/blogs/the-movies-blog/get-out-alternate-ending-2254624